Minimally Invasive Surgical Treatment for Vertebral Artery Compression in a Patient with One-Sided Ponticulus Posticus and Ponticulus Lateralis.

BACKGROUND

Kimmerle anomaly is characterized by ossification of the posterior atlanto-occipital membrane with formation of a complete or incomplete bony ridge in the area of the groove for the vertebral artery (VA) (ponticulus posticus [PP]). In some cases, the bony ridge may also be formed at the level of the VA emerging from the transverse process of the С1 vertebra (ponticulus lateralis [PL]). Simultaneous 1-sided formation of PL and PP is very rare. Data concerning surgical treatment for compression of the VA owing to PL are lacking.

CASE DESCRIPTION

A 34-year-old woman presented with significant dizziness to the point of losing consciousness while rotating her head to the left. Computed tomography angiography of the cervical spine revealed С1 anomaly with the formation of PP and PL with acute-angled С-shaped kinking of the VA. The patient underwent resection of the bony ridges through minimally invasive lateral (PP) and far-lateral (PL) approaches. Treatment led to significant improvement in quality of life, with disappearance of the pain syndrome via the С1 spinal root and absence of bow hunter's syndrome in the postoperative period.

CONCLUSIONS

This is the first report to our knowledge on the surgical treatment of VA compression owing to PP and PL. VA decompression in such cases can be performed via 2 separate minimally invasive lateral and far-lateral approaches. Surgical strategies for treatment of Kimmerle anomaly may significantly improve patients' quality of life.